Provider Demographics
NPI:1295002822
Name:501 C OUTSOURCE CORPORATION
Entity Type:Organization
Organization Name:501 C OUTSOURCE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FOSS
Authorized Official - Suffix:
Authorized Official - Credentials:ITDS
Authorized Official - Phone:239-543-5856
Mailing Address - Street 1:15397 MOONRAKER CT APT 603
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-3100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15397 MOONRAKER CT APT 603
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917-3100
Practice Address - Country:US
Practice Address - Phone:239-543-5856
Practice Address - Fax:239-543-5856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty